Data Visualization flexdashboard | Abigail Burns, Sharon Jepkosgei, Chizoma Oparaji, Jannelle Marie Navales
Purpose
This project illustrates public spending on prescription drugs and the effect of regulatory legislation over time.
Background
More than 131 Million people (66% of adults) in the US use prescription drugs
Prescription drugs are vital to maintain/improve health
The rising cost of prescription drugs = overburdened public healthcare systems and individual family budgets across the country
Affordability & accessibility is vital
Research Question
Do prescription drug policies and regulations have a direct impact on the affordability and accessibility of prescriptions over time?
Research Hypothesis (H1)
Prescription drug policies and regulations have had a measurable impact on affordability and accessibility of prescriptions.
Philosophy
More like Wickham’s approach (not Tufte’s simplicity)
Layered Approach - Building visualizations through layers (adding scales and aesthetics)
Customization - Customize visualizations extensively, allowing for fine-tuned control over every aspect of a chart.
Interesting and easily interpreted visualizations.
The prices of popular statins (medicines which lower blood cholesterol levels) have been on the rise in the past decade
The prices of popular antianaphylactics (medicines which treat and prevent allergic reactions) peaked between 2018-2019
Rising Prices
Trend
The average cash price per insulin unit rose 54% from Jan. 2014 to April 2019
Dosage price then dropped 10.6% from Jan. 2020 to July 2023, a period of economic decline
High costs, High risks
There was a drop in diabetes medication use in 2018 which has not since recovered
The high cost of insulin forced many people to ration their usage
People in the U.S. either skip, delay or use less insulin than is needed on a daily basis throughout the year
Insulin rationing can have dire health consequences
Analysis
We found a possible explanation for the drop in insulin usage in 2018.
According to the chart, in 2018, the average list price for one vial of insulin in the U.S. was $98.70
This dosage price is up to 10x more than other countries in the OECD
Why is this important?
People with Type 1 diabetes need on average 1 to 3 vials of insulin per month
Patients with Type 2 diabetes don’t always need to take insulin, but those who do can sometimes require more than those with Type 1
Inflation Reduction Act (IRA): Effect on Manufacturers

Went into effect in January 2023
Patients who are covered under the Medicare Part D plan now have a $35 out-of-pocket monthly cap for their insulin
Higher rebates, even exceeding 100% of a drug’s price, in cases when manufacturers have raised list prices sharply over time triggering large best price discounts
Under the IRA, manufacturers will face penalties in Medicare for raising list prices faster than inflation

The map shows the estimated out-of-pocket savings by state if the IRA had been in effect in 2020
Webscraped data from USDHHS report
Total savings to beneficiaries: $734 million in Part D and $27 million$27 million in Part B
Average yearly savings of approximately $500 for Medicare beneficiaries
States with the most people on Medicare projected to benefit from the new IRA insulin cost savings:
- Texas 114,000 beneficiaries
- California 108,000
- Florida 90,000
- North Dakota $805
- Iowa $725
- South Dakota $725
[1] "LLY"
Impact of regulation
Facing pressure to curb diabetes-treatment costs, Eli Lilly & Co. announced on March 1 that it is slashing insulin prices
They immediately capped the out-of-pocket cost of all of its insulin at $35 a month
The graph shows Eli Lilly & Co. stock prices from June 2022 to most recent data
From the graph reduction in insulin price has not affected the bottom line of Eli Lilly & Co.
Future impact
IRA only applies to those with Medicare
But, medicare is the largest single purchaser of prescription drugs in the US
This might further deter drug makers from increasing prices each year while offering greater rebates to insurers
[1] "NVO"
Novo Nordisk and Sanofi are other dominant insulin manufacturers that announced they have drastically lowered list prices and out-of-pocket costs in March 2023.
Novo Nordisk stock prices have an upward trend
The graph shows how affordability of prescription medication varies by insurance, coverage type, and income.
Affordability problems increase as income falls and are much higher among those without insurance coverage
People with diabetes enrolled in high-deductible plans report greater affordability problems than those in conventional private insurance plans
The Affordable Care Act (ACA)
Prices increased rapidly between 2007 and 2017
But, coverage expansions reduced the share of those with diabetes in each income group who reported difficulty affording prescription drugs.
The greatest declines have been among people with incomes between 100 percent and 300 percent of the federal poverty level
Case for Medicaid expansion
Our analysis suggests that the most important factors affecting the affordability of insulin are:
the availability of coverage
the form of that coverage
People with adequate coverage are often shielded from these price increases.
Medicaid also provides patients with diabetes and other diseases
more predictable out-of-pocket expenses
better access to regular care